| NPI | 1699271619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 2020-01276) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 2020-01276) |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2022-11-23 |